THE INCIDENCE AND MANAGEMENT OF RECTAL INJURY ASSOCIATED WITH RADICAL PROSTATECTOMY IN A COMMUNITY-BASED UROLOGY PRACTICE

Purpose: We assessed the use of combination bowel preparation before radical prostatectomy. Materials and Methods: We reviewed 533 radical prostatectomies performed from 1984 to 1994. All patients underwent preoperative combination bowel preparation. The incidence, management and sequelae of rectal injury were determined. The literature addressing the management of rectal injuries was reviewed. Results: Rectal injury occurred in 8 patients (1.5%). Injury was recognized intraoperatively and repaired primarily in 6 cases, and repair included colostomy in 2. Injury was recognized postoperatively as recto-urinary fistula in 2 cases and initial management was conservative. No fistula closed with conservative management. There were no pelvic abscesses and no deaths. Conclusions: Combination bowel preparation permits safe closure of rectal injury at radical prostatectomy without the necessity of routine colostomy. In the event of recto-urinary fistula, conservative management is not warranted.